The California Department of Public Health ran this billboard ad, titled "Chemo," in 1999 as part of its statewide tobacco control program.

Over a span of nearly 20 years, California’s tobacco control program cost $2.4 billion and reduced health care costs by $134 billion, according to a new study by UC San Francisco (UCSF).

Additionally, the study – covering the beginning of the program in 1989 to 2008 – found that the state program helped lead to some 6.8 billion fewer packs of cigarettes being sold that would have been worth $28.5 billion in sales to cigarette companies.

The study was designed to calculate the fiscal impact of California’s large public health program on smoking prevalence and cigarette consumption. UCSF has been at the forefront of tobacco research for decades, disclosing how the tobacco industry manipulated its products and led the public into cigarette addiction. The UCSF Legacy Library houses more than 13 million documents on file that were released as a result of litigation against the major tobacco companies related to their advertising, manufacturing, marketing, sales, political, public relations and scientific activities.

The new research shows that tobacco control funding is directly tied to reductions in both the prevalence of smoking and cigarette consumption per smoker – and generates significant savings in overall health care expenditures.

“These health care cost savings began to appear almost immediately after the program started and have grown over time, reaching more than $25 billion a year in 2008,” said first author James Lightwood, PhD, a UCSF associate professor of clinical pharmacy.

The study was published online on Feb. 13 in the journal PLOS ONE.

Every year, an estimated 443,000 people in the United States die from smoking or exposure to secondhand smoke, according to the federal Centers for Disease Control and Prevention (CDC). Another 8.6 million people suffer from a serious smoking-related illness. Annually, costs associated with smoking-related illness account billions in medical expenses and lost productivity, and 5.1 million years of potential life lost in the United States, the CDC reports.

To help save lives and lower health care costs, California passed Proposition 99 in 1988 to create a tobacco control program.

The voter-funded state program centers on changing social norms around smoking to reduce smoking and tobacco-induced diseases.

The program combines an aggressive media campaign with community programs emphasizing three themes:

That the tobacco industry lies;
That nicotine is addictive;
That secondhand smoke kills.

The new UCSF research updates an earlier study by the same authors, adding five years of data and a more sophisticated economic analysis. The earlier paper covered 1989 through 2004.